Orthopractic Unveiled

An exclusive interview with Ronald L. Slaughter, DC, national executive director, National Association of Chiropractic Medicine (NACM).

"DC": Dr. Slaughter would you please give us an introduction to the orthopractic movement and who is involved?

Dr. Slaughter: Yes, I would be quite happy to. In fact, I really appreciate this opportunity to do this because there does seem to be a lot of confusion out there. I know Dr. (Murray S.) Katz of our Canadian affiliate was called just last week by a leading, well-known chiropractic researcher who is highly respected, who simply had heard the term (orthopractic) and wanted to know what it was all about. A week or so ago, I was called by a former ACA executive official with the same reason.

What is the orthopractic movement? Essentially, it's a multidiscipline that is medical doctors, osteopaths, chiropractors, physical therapists with a common interest, and that common interest being spinal manipulative therapy, who have come together to try to formulate guidelines for this scope of practice, ethics, and so on and so forth. Essentially that's what the movement is.

"DC": Who is involved?

Dr. Slaughter: Who is involved? Let me tell you what is involved. The orthopractic movement is more than one organization. There is the Orthopractic Manipulation Society International, the Orthopractic Manipulation Society of North America (OMSNA), this is the Canadian group, and the Orthopractic Manipulation Society of USA, which is the American group. There are going to be in formulation right now other organizations.

I would not be surprised very soon to see Orthopractic Manipulation Society of Australia, New Zealand, Europe, Germany, England, France, whatever. But what they have is a common interest in spinal manipulative therapy and under the umbrella of the Orthopractic Manipulation Society International, and we're all sister/affiliate groups. Belonging to one belongs to all.

"DC": Why has the National Association of Chiropractic Medicine decided to establish the Orthopractic Manipulation Society in the United States?

Dr. Slaughter: Well, that's kind of interesting. You understand, and I think there are some chiropractors who do not understand, that the American Chiropractic Association, like the American Medical Association and other organizations such as this, are political organizations. They're essentially PR organizations for professionals.

The National Association for Chiropractic Medicine was never a political organization, in fact it was essentially apolitical. It was formulated as a consumer advocacy organization essentially for consumer protection. Because of the nature of the NACM and the fact that we had originated by renunciation of chiropractic philosophical practice, we attracted the attention of scientific medicine. Not political AMA, but scientific medicine.

So when the orthopractic movement got started, and it began medically, the NACM was approached simply because it had scientific credibility. I do believe that if it had not been for the NACM, the chiropractic profession would not have been invited to be a part of this movement.

"DC": Some people are suggesting that the orthopractic movement is attempting to destroy the chiropractic profession. How would you respond to that?

Dr. Slaughter: I would say that's nonsense. In fact if you just get down to the bottom line, if you really look at it and look at it closely, there's only two types of chiropractors and I've just kind of outlined that. There are those chiropractors who are subluxation-based, they believe in the chiropractic hypothesis or philosophy of disease causation. They consider themselves an alternative to medical care, they consider themselves to be primary care providers, and they're essentially anti-science, anti-medicine, and anti-surgery.

Alternatively, there are other chiropractors who have no belief system in chiropractic philosophy. They practice SMT (spinal manipulation therapy) as an applied science to treat joint dysfunctional health problems, they do not consider themselves an alternative to medicine, but rather self-limited medical specialists. They do not consider themselves as primary care providers but do consider themselves as portal of entry care providers. They recognize and accept that the world body of health science knowledge is an ever-changing and a progressive chain of knowledge producing more knowledge.

That being the fact, I think that these two groups are pretty much at opposite poles. They're irreconcilable positions where there could be very little chance for compromise there. And I think it's probably at a point in time that these two different types of practitioners, heretofore having called themselves chiropractors, be able to separate themselves.

I was called and I went to the office this morning and I saw a doctor of chiropractic because he called me, because he was in trouble. He had a bad back. This gentleman is as far removed from me philosophically as you can possibly get yet he has respect for me and my ability to take care of problems, just as I have respect for him and his ability to take care of my problems. We have mutual respect but we do not agree on this business of philosophical practice versus applied science practice.

That being the case, I see no reason whatsoever why we cannot have a division with those practitioners who wish to practice spinal manipulative therapy as an applied science going one way, and those chiropractors who wish to practice historical, philosophical practice going the other way.

Why do we have to have bitterness over this? For the first time, and I believe because of the efforts of the NACM going back for many, many years now -- in fact I gave an address at St. Mary's Hospital in Kansas City, Missouri in 1987 at the invitation of the Food and Drug Administration where I advocated what medicine is currently doing, and that is offering a position for those chiropractors who wish to practice according to scientific parameters, the opportunity to work with mainstream medicine.

That's essentially what the chiropractic division of the orthopractic movement is all about. Does that answer your question?

"DC": I think it does. In a letter recently written by you, you state, "Canadian, New Zealand, and Australian medical organizations have voted to adopt the orthopractic model." Can you expound on that?

Dr. Slaughter: Dr. Katz, who is one of the medical originators of this movement in Canada, recently published an article in the Medical Post which has a medical circulation of 50,000 practitioners in Canada, and I believe it was last Friday he spoke before the entire colleges of physicians and surgeons in Canada. Some of the colleges of physicians and surgeons have already adopted the orthopractic model as a guide for spinal manipulative treatment and it is expected that within two weeks, we hope, all the colleges of physicians and surgeons in Canada will have adopted this model. Is there any further question that you have in that regard?

"DC": No, that's about it. So if you want to expound, go ahead.

Dr. Slaughter: That's kind of the bottom line. As this message is getting out to the medical profession, we're finding on a local level as well as a national level that the medical profession who, whether we like it or not, controls health care delivery in the entire world much less the United States, they're quite happy with this because it gives them the opportunity to work with a practitioner with skills in spinal manipulative therapy, wherein they know exactly the parameters of his or her scope of practice. It removes an obstacle for them. We expect widespread medical adoption of this model, not just in the United States or Canada, but worldwide.

"DC": Mentioning Dr. Katz in that same letter, you state, "The AMA is in discussion with Dr. Katz (OMSNA) at this time for adoption. We are confident that they will wish to open the door for all medical associations." Can you expound on that?

Dr. Slaughter: I don't know where you got that. I don't even remember. There's been so much communication lately, but I can tell you this, there has been communication between legal counsel for the American Medical Association and Dr. Katz and/or Dr. Katz's OMSNA to the extent to that communication I can't tell you and I don't know where it will lead.

"DC": Additionally, that same letter seems to suggest a certain involvement by either the NACM or OMS in several of the upcoming media reports (on chiropractic) including Consumer's Report and apparently another Wall Street Journal article.

Dr. Slaughter: There's been a number of our members as well as many, many other chiropractors across the country, whether they were members of our organization or not, that have been contacted. I think most of the profession is aware of the fact that Consumer's Report is writing an article on chiropractic. As you well know they already published articles on homeopathy, acupuncture, and the like. In some ways, this is a follow-up on an article they did some 20 years ago on the chiropractic profession. We certainly have had input in that.

"DC": Considering some of the other input with the previous Wall Street Journal article, the Pediatric Management article, the "20/20" expose, and now the Medical Post (Canada) article that you mentioned from Dr. Katz, some would suggest that perhaps your group is working with the media in an attempt to decimate the chiropractic profession.

Dr. Slaughter: If anyone thinks that you're working "with the media," I don't think that they've had any exposure to the media. As you well know Mr. Petersen, you never know what the media is going to say, you never know what they're going to take out of context.

You may or may not have had this happen to you, but I know that members of our organization have had the news media come to their offices, tape two or more hours of tape, and give them a 20-second bite. We've seen this with all kinds of reporting. The news media apparently has an agenda and they stick to that agenda.

Now, there is one thing I would like to say, however. And I think everyone is, or they should be aware the fact that in regard to Consumer's Report, here is a publication that is outstanding. You cannot "buy" Consumer's Report; General Motors cannot buy it; IBM cannot buy it. They're going to publish what they consider to be in the consumer's interest. If there's ever going to be a report written by anybody with no bias, it's going to be by Consumer's Report.

"DC": You are also apparently planning a letter writing campaign to members of Congress. What will be the nature of that?

Dr. Slaughter: No, I'm not planning to do that at all. The OMSNA is much better organized at this point than we are, we're a sister affiliate of course, but they have something like 10 different committees that are working on different things at the same time. I believe that one of those committees is working in that regard.

"DC": Can you give us some idea what the nature of that letter writing campaign will be?

Dr. Slaughter: I wouldn't have any idea being that I'm not part of that committee. I'm sure it's going to be something in regards to parameters of scientifically acceptable spinal manipulative therapy, you can be assured of that.

"DC": Your letter also mentions that "a chiropractic college is being challenged to convert to our first orthopractic college."

Dr. Slaughter: There has been, I'm not a part of that either, but I do know that there has been some preliminary contact toward this end and there has been some preliminary interest shown.

"DC": Wouldn't that require that college to more or less forsake its accreditation?

Dr. Slaughter: Yes, it certainly would. If the orthopractic movement reaches a point where a new profession is born and should such time as we have an educational facility for the production of orthopractic practitioners, I can pretty much assure you that that particular facility will absolutely have to be university-based. We would not accept an educational facility that was not a part of a university-based system.

"DC": In creating that new profession ...

Dr. Slaughter: I didn't say we were going to, I said if it moved in that direction.

"DC": Okay. Some of your worst critics, in noting some of the information coming out of the NACM about the Orthopractic Manipulation Society, have suggested that its merely an attempt to build members, and they further suggested that it's a fear tactic that promises little more than membership dues and rhetoric. How would you respond to that?

Dr. Slaughter: Again, I'll have to say to you that first of all, this movement is not about chiropractors. This movement is about medical doctors, osteopaths, physical therapists, and thank God, chiropractors. The OMSUSA is only one division of a much larger organization. Members of one part of this organization essentially are members of all. That is, we would regard members of the OMSNA as members of the OMSUSA as far as their support is concerned.

So considering the fact, let's just take a "for instance": One of the physical therapists organizations that supports the orthopractic movement alone has membership of 20,000 practitioners and the head of that organization has given 100 percent support of the orthopractic movement, and has suggested to all that membership that they become members. We have one member of the OMSUSA who's got a mailing list of 8,000 members and another who has a mailing list of 3,000 members of chiropractors who have demonstrated great dissatisfaction with the profession as it exists today. Now whether or not they will all become members or not remains to be seen.

I'll tell you what we have done in the event that you do believe that we're doing these things just to get membership -- our membership is already voted to absolutely cap all applications at 1,000 for the time being. It does not mean that we're going to try to refuse membership to any chiropractor, we're quite willing to accept applications from anyone, it does not mean that we're trying to exclude anyone, it simply means that we felt that as membership approached 1,000 we needed the time to establish the investigative committees and the credentialing committees to be able to determine who would be able to fit within the parameters of these guidelines and who possibly could not or would not want to.

Remember, this is not about chiropractors, so we also have to worry about the credentialing of physical therapists, osteopaths, and medical doctors, because as you and I both know, we don't know the extent of their training. We certainly cannot establish credentialing for those people -- that is, chiropractors can't establish the credentialing -- we have to rely upon our physical therapy, osteopathic and medical members to help us do so.

Do you understand what I'm getting at? This is not about chiropractors, that's what the bottom line here is. This is about spinal manipulative therapy. They are two different things and the chiropractic profession simply has not been able to understand that in the past.

"DC": Looking at membership for a moment, what are the rights of members? Can they elect officers, board members, effect policy, etc.?

Dr. Slaughter: Oh, absolutely. Absolutely. Everything is based upon membership vote. We are working on a constitution that would only be alterable by a full majority of membership vote. Don't forget that these are all sister organizations.

It has been suggested that they're might be a large influx of chiropractic practitioners trying to join OMSUSA to do just exactly what you're kind of getting at here, that is, to change things. It's just not going to be possible because of the constitution and our affiliate organizations. Not only membership of the OMSUSA would be required but voting membership of our other organizations as well. It's not going to happen.

"DC": So this is going to be an organization that will be tied to the other organizations in terms of what kind of policy it sets?

Dr. Slaughter: Absolutely. This is and will be and will always remain a multidiscipline movement.

"DC": Is there anything else you would like to add?

Dr. Slaughter: I would like to say that I hope that philosophical chiropractors, that is, chiropractors who believe in practicing philosophical practice, will not consider this an attack. We believe in living and let living. We believe that this was the direction that the chiropractic profession should have made some years ago.

I went to the governing board of the ACA way back in the '80s and I suggested to them at that time that time would tell that we should define our scope of practice so that we could fit into a national health care picture at some date. That was not done.

Today, the chiropractic profession still sees only six percent of the total population even though 89 percent of that six percent come for only muscle/joint pain types of disorders. The chiropractic profession never did see this, they never did learn this lesson. They never did appreciate the fact that 94 percent of the population were ignoring the chiropractic profession and essentially were ignoring it because of the philosophical dogma of which they espoused.

And the chiropractic profession didn't realize either that that 94 percent out there had a heck of a lot of people with back pain, back pain that needed to be addressed by spinal manipulative therapy, that were never going to get that. Now, spinal manipulative therapy has received that endorsement from outside independent study that I knew that it would at some point because it was just too effective for common low back pain. I think that research will show that we have the same efficacy for other spinal/joint problems in the future and there are chiropractors like myself who feel an obligation and a responsiblity to that other 94 percent of the population.

We're quite happy to be back doctors, we think it's quite an important area to play considering that back pain is almost universal in Western industrialized nations. At some point in one's life they're going to suffer a disabling back condition. They deserve the very best treatment. The very best treatment known right now by multiple independent studies is spinal manipulative therapy.

What we had to do is find a profession for spinal manipulative therapy and the chiropractic profession removed themselves by virtue of the dogma they espouse. Why philosophical chiropractic should be angry with those practitioners who wish to provide that treatment in mainstream health care, I couldn't possible imagine.

We're not going to try to convince them not to continue to provide the services that they provide and we're certainly not going to try to destroy the chiropractic profession. We are going to try to see that 94 percent of the population that they have never seen and we're also going to try to see the 89 percent of the six percent that they have seen. Perhaps that is competition, but that's what makes the marketplace.

"DC": Thank you Dr. Slaughter.